Could You Have Obstructive Sleep Apnea?

Feeling groggy? Does your bed partner observe you gasping for air at night? If so, you might have obstructive sleep apnea (OSA). One of the most common sleep disorders, OSA affects approximately 5 to 6 percent of the adult population and 2 percent of children. (9,10)

Unfortunately, our own research suggests more than two-thirds of all people with sleep apnea are not diagnosed. If left untreated OSA can increase the risk of other serious chronic conditions such as diabetes and heart disease.

This is precisely why World Sleep Day 2012 focuses on raising awareness of sleep health issues. This year's theme, "Breathe Easily, Sleep Well," is dedicated to building awareness of disorders that affect your breathing, such as OSA. World Sleep Day, organized by the World Association of Sleep Medicine, takes place today, March 16.

A good night's rest is still within reach if you recognize the warning signs and seek proper care.

What is obstructive sleep apnea?

OSA is characterized by repetitive collapse of the upper airway (behind the tongue, uvula, and soft palate) during sleep. Your upper airway relies on muscle activity to stay open. As you sleep, muscle activity falls and most people experience small reductions in airway size with no adverse repercussions. Others experience larger changes in airway dimensions, which is associated with snoring. Finally, when muscle activity declines in people who have a small airway to begin with, it can lead to complete or near complete collapse and prevent breathing entirely. This scenario is what is widely known as apnea.

When your breathing is disrupted as described above, your body increases its effort to breathe as a response to falling oxygen levels in the blood. If you are sleeping when this occurs, you'll generally have to wake up briefly to begin breathing again. After you awaken it takes several large breaths to correct the low oxygen levels (1, 2). Thus, people that have severe sleep apnea will be roused from sleep hundreds of times over the course of a night in order to breathe.

What are the warning signs?

The most common cause of OSA is weight gain. As obesity levels rise, your airway tends to shrink and the risk of sleep apnea increases (3). Men are two to three times more likely to have sleep apnea than women and you are more likely to get sleep apnea as you get older. In addition, women more commonly develop OSA after menopause. At this time, why gender, age and menopausal affect apnea is not completely understood (4).

Other signs and symptoms of sleep apnea include (4):

• Frequent loud snoring
• Pauses in breathing (apneas) or gasping for breath
• Common measures of obesity: Body Mass Index (BMI) >25-30 kg/m2 or neck circumference > 16.5 inches in men and 15.5 inches in women.
• Regularly falling asleep in passive situations (reading, watching TV, driving)
• High blood pressure

Does OSA lead to other health problems?

OSA can lead to a number of problems. Poor quality sleep is associated with increased daytime sleepiness, poor concentration, reduced memory, increased job-related and automobile accidents, and generally reduced quality of life. OSA can contribute to hypertension, diabetes and atherosclerosis (3). In addition, there is an evolving body of literature suggesting that OSA may lead to heart attacks, strokes and the development of congestive heart failure.

How do you treat it?

The most common treatment for OSA is nasal Continuous Positive Airway Pressure (CPAP). CPAP is a blower connected with a small hose to a mask worn over the nose or nose and mouth (5). The blower generates pressure in the mask which is transmitted to the upper airway to keep it open during sleep. It must be worn every night. CPAP will almost always eliminate snoring and OSA.

Some sufferers find the mask and pressure uncomfortable. As a result, there are now a number of different masks and ways to deliver the pressure such that the majority of patients use CPAP successfully. If anyone with OSA cannot use CPAP there are other alternatives, although none are as universally successful.

Sometimes, a behavioral approach to treatment is needed. For example, some patients simply need to lose weight or adjust their sleeping position (stay off the back). Dental appliances that gently pull the lower jaw forward work for many patients as well. If neither of these provides a remedy, there are a number of surgical procedures designed to increase the size of the airway (6). These commonly involve either removing or stiffening the soft palate, reducing the size of the tongue, or moving the tongue structure forward. Short of fairly aggressive surgery, this approach does not have a high success rate.

If left undiagnosed or untreated OSA can lead to a reduced quality of life and a potentially increased risk of adverse cardiovascular events. If you believe you or a loved one may have sleep apnea, talk to your doctor about it. You will be glad you did.

References:

1) White DP. Sleep apnea. Proc Am Thorac Soc. 2006;3:124-8.

2) White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med. 2005 Dec 1;172:1363-70.

3) Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T. Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med. 2005 Nov 14;165:2408-13.

4) Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004 Apr 28;29:2013-6.

5) Bradley TD, Floras JS. Obstructive sleep apnea and its cardiovascular consequences. Lancet. 2009 Jan 3;373:82-93.

6) Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med. 1994 Nov;150:1279-85.

7) Sánchez AI, Martínez P, Miró E, Bardwell WA, Buela-Casal G.CPAP and behavioral therapies in patients with obstructive sleep apnea: effects on daytime sleepiness, mood, and cognitive function. Sleep Med Rev. 2009 Jun;13:223-33.

8) Caples SM, Rowley JA, Prinsell JR, Pallanch JF, Elamin MB, Katz SG, Harwick JD Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis. Sleep. 2010 Oct;33(10):1396-407.

9) Young T et al. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165: 1217-1239

10) Redline S et al. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med 1999; 159: 1527-1532

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